Construct Validity and Reliability of the Children Participation Assessment Scale-Child version in Children with Physical Disabilities

Objective This study was conducted to determine the construct validity and reliability of the Children Participation Assessment Scale in activities outside of School–Child version (CPAS-C) in 6-12-year-old children with physical disabilities (PDs). Materials & Methods In this methodological study, participants were 100 children with PDs, recruited from a school for exceptional children with physical-motor disabilities and 100 normally developing children. For assessing the test-retest reliability (ICC), 40 children with PDs completed CPAS-C within a two-week interval, and for assessing the internal consistency (Cronbach's alpha) and construct validity, 100 children with PDs separately completed the Vinland Adaptive Behavioral Scale (VABS) and CPAS-C. Result The majority of participants were children with CP, among whom the highest and lowest ratios were related to diplegia (32%) and dystonia (1%), respectively. The results showed that CPAS-C had acceptable reliability (ICC: 0.6-0.99). Cronbach’s α score was between weak to moderate (α = 0.25-0.75). The difference in the score of participation between the two groups (normally developing children and children with physical disabilities) was significant in all areas (P<0.001). Conclusion The CPAS-C had acceptable psychometric properties; it can be used as a valid and reliable tool for assessing the participation of 6-12-year-old children with PDs in school activities.


Introduction
Physical disability is a limitation in physical functioning, mobility, dexterity, or endurance, which results in impaired body functions and structures, as well as reduced activities and participation in tasks (1). Children with physical disabilities, including cerebral palsy (CP), muscular dystrophy, etc., due to the motor and other associated disorders, have limitations in participation in physical activities, play, leisure, and educational school activities (2). Studies show that children with physical disabilities participate less in various activities than their normal peers (3)(4)(5). Also, their activities have limited variability, and they are more likely to participate in home activities and the tasks that are less physically and socially engaging (6)(7)(8). Children with physical disabilities are at risk of occupational deprivation (9,10). According to studies, personal (i.e., age, gender, and executive skills) and environmental factors affect the pattern of children's participation in activities (11). Therefore, the pattern of participation can vary from country to country (5). Since studies have proven that culture has an impact on the patterns of children's participation, it is necessary to assess the participation of children with physical disabilities in activities in various cultures (12). The Occupational Therapy Practice

Participants
The study population included 6-12-year-old children with physical disabilities and their normal peers of the same age, recruited by the convenience sampling method. The sample size for test-retest reliability was 40, and to assess the internal consistency and construct validity, 100 children with physical disabilities and 100 normally developing children, attending special children's and ordinary schools in four regions of Tehran (i.e., north, south, west, and east) were enrolled (18,19). Inclusion criteria for children with physical disabilities were fluency in Farsi, age of 6 to 12 years, and the lack of cognitive problems.
The children who met the inclusion criteria were screened, and informed consent was obtained from their parents. Two instruments were used in this study. The first was an instrument which was In typically developing children, the internal consistency of these dimensions varies from 0.83 to 0.85, and the test-retest reliability was reported to be 0.91-0.93 (17).

Vinland Adaptive Behavior Scale
Vinland Adaptive Behavior Scale (VABS) is a parent-report scale that is completed by semi- In this study, VABS was selected for convergent validity since it was the only tool evaluating the dimensions which were similar to those of CPAS-C.
In fact, VABS is commonly used in narrative studies and compilation tools for participatory assessments (21,22). The overall internal consistency of the Persian version of VABS was reported to be 0.98 (23). In this study, the items related to the ADL, communication, and socialization of 6-12-year-old children were investigated.

SPARCLE Questionnaire
This questionnaire is completed by parents to estimate the cognitive level of children with CP. In the present study, children with a cognitive level of over 70 were included.

Statistical Analysis
SPSS software version 20 was used for data analysis. For the internal consistency and test-retest reliability, the Cronbach's alpha and Intraclass Correlation Coefficient (ICC) were used. Also, Pearson correlation was used to assess convergent validity, and the Independent t-test was used to compare the participation scores of children with physical disabilities with those of their normal peers.

Results
The age of children with PDs and their normal peers was between 6 and 12 years old with a mean age of 8 Table 2). Participation scores in all occupation areas were significantly different between normally developing children and those with CP (P <0.001, Table 3).

Discussion
The purpose of this study was to assess the   (5,26,27). This could be due to the tiredness of physically-disabled children, the lack of paying attention by the family and community to these children's activities, the lack of motivation in these children, and the lack of proper feedback for their participation.

In Conclusion
In this study, the Children's Participation Assessment Scale -Child version that evaluates all eight occupation areas (i.e., ADL, IADL, play, leisure, social participation, education, work, and sleep/rest) delivered acceptable psychometric properties (i.e., construct validity and convergent, divergent, and internal consistencies). Therefore, it can be used as a valid and reliable scale for assessing the participation of 6-12-year-old children with PDs. It can also be utilized as a guide for interventional experiments and a comprehensive framework for clinical evaluations.